The relationship between earthquake risk perceptions, religious orientation, spiritual well-being in individuals with and without earthquake experience: a cross-sectional study

The physical and psychological effects of earthquakes on individuals with their experience dimension are important. This study aimed to examine the relationship between earthquake risk perception, religious orientation, and spiritual well-being among individuals with and without earthquake experience. The data collection instruments included a socio-demographic information questionnaire, earthquake risk perception scale, religious orientation scale, and three-factor spiritual well-being scale. Statistical evaluations were performed using independent samples t test, one-way ANOVA test, Mann–Whitney U test, Kruskal–Wallis test (Levene), Pearson correlation, and multiple linear regression analyses. About 59.9% of the participants had experienced an earthquake. Individuals with earthquake experience scored 33.04 ± 7.80 on the earthquake risk perception scale, 100.65 ± 20.80 on the religious orientation scale, and 119.66 ± 18.87 on the three-factor spiritual well-being scale. Those without earthquake experience scored 31.57 ± 7.74, 96.70 ± 18.46, and 114.09 ± 18.04 on the respective scales. The average scores on the earthquake risk perception scale were found to be statistically significant with respect to gender, while the average scores on the religious orientation scale and the three-factor spiritual well-being scale were found to be statistically significant with respect to both gender and substance use. The regression analysis revealed that religious orientation and three-factor spiritual well-being significantly predicted 13.5% of the variance in earthquake risk perception. Studies to increase individuals’ risk perception are important in minimizing the destructive effects of earthquakes in countries in the earthquake zone.


Population-sample
The study population consists of a total of 3350 individuals studying in both schools.For statistical tests to meet their basic assumptions, the sample size needs to be adequate, and there is a requirement for making good inferences about population parameters (reducing sampling error and providing sufficient power) 24 .In cases where the population is known, it is deemed sufficient to reach 345 individuals with a 95% confidence level and a margin of error of 0.005 using the known population sampling formula (N = 604) 25 .Since data collection is planned to be conducted online in the research, convenience sampling method has been planned for data collection.Convenience sampling method is the easiest, fastest, and most economical way to collect data from the population.It is one of the most commonly preferred methods 26 .By using convenience sampling, individuals were divided into groups and only volunteers participated in the study.The study was completed with the participation of a total of 604 individuals, including 362 individuals with earthquake experience and 242 individuals without earthquake experience.After the study was completed, a post hoc test was conducted using the standardized mean scores of the spiritual well-being scale with GPower 3.1.9.4.software.An effect size of 0.301 was found, and the power analysis conducted with sample sizes of 242 and 362 revealed a power of 0.976.

Data collection tools
Socio-demographic ınformation questionnaire This form consists of 19 questions developed by the researchers, including socio-demographic characteristics and other influencing factors [27][28][29] .

Earthquake risk perception scale
The scale was developed by Trumbo et al. and adapted into Turkish by Mızrak et al. 29,30 .It consists of 8 items and uses a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).The scale has two subscales: emotional risk perception (items 1-4) and cognitive risk perception (items 5-8).The scale has satisfactory internal consistency with a total Cronbach's alpha of 0.857, emotional risk perception subscale Cronbach's alpha of 0.805, and cognitive risk perception subscale Cronbach's alpha of 0.859.For this study, the overall Cronbach's alpha was found to be 0.932, emotional risk perception subscale Cronbach's alpha was 0.932, and cognitive risk perception subscale Cronbach's alpha was 0.924.

Religious orientation scale (ROS)
ROS, developed by Harlak and Eskin was used in this study.It consists of 25 items and three dimensions: Intrinsic Religious Orientation (12 items), Extrinsic Religious Orientation (6 items), and Quest Religious Orientation (7 items) 27 .The internal consistency of the subscales was determined with Cronbach's alpha coefficients, which were found to be α = 0.76 for Intrinsic Religious Orientation, α = 0.70 for Extrinsic Religious Orientation, and α = 0.67 for Quest Religious Orientation.For this study, the overall Cronbach's alpha was 0.928, Cronbach's alpha for the Intrinsic Religious Orientation subscale was 0.862, Cronbach's alpha for the Extrinsic Religious Orientation subscale was 0.771, and Cronbach's alpha for the Quest Religious Orientation subscale was 0.801.

Three-factor spiritual well-being scale
The three-factor spiritual well-being scale was developed by Ekşi and Kardaş for adults to determine individuals' understanding and living processes of life in terms of their personal values and meanings, including unique, social, and transcendent aspects 28 .The scale consists of a total of 29 items.The response options in the five-point Likert scale range from 1 (not at all appropriate for me) to 5 (completely appropriate for me).The scale has three subscales: transcendence, harmony with nature, and anomie.The Cronbach's alpha values of the scale were found to be 0.953 for transcendence, 0.864 for harmony with nature, 0.853 for anomie, and 0.886 for the total scale.The fit indices of the model were as follows: x 2 /sd = 4.11, RMESEA = 0.06, SRMR = 0.50, NFI = 0.90, CFI = 0.92.It was observed that individuals who obtained high scores on the scale had high levels of spiritual well-being, while those who obtained low scores had low levels of spiritual well-being 21 .The scale name has been changed by the authors due to the similarity with a different scale name 31 .When calculating the total score, the items in the anomie subscale (items 3, 7, 11, 15, 19, 23, 26) are reverse scored.For this study, the overall Cronbach's alpha was 0.943, Cronbach's alpha for the transcendence subscale was 0.964, Cronbach's alpha for the harmony with nature subscale was 0.912, and Cronbach's alpha for the anomie subscale was 0.878.

Data collection method
The survey for the study will be distributed to individuals via social media platforms (WhatsApp, Facebook) using a survey adaptation program (Google Docs).It is estimated that each survey will take approximately 15-20 min to complete.

Data analysis
The researchers evaluated the data obtained in the study using the SPSS (Statistical Package for Social Sciences) 26.0 software on a computer.Descriptive statistics such as frequencies, percentages, means, and standard deviations were calculated for the data.Skewness and Kurtosis values within the range of ± 2.0 were considered indicative of normal distribution 32 .Values within this range were considered to have a normal distribution.Independent samples t tests were used to compare scale means between two groups that exhibited a normal distribution, while one-way ANOVA tests were used for three or more groups that exhibited a normal distribution.For non-normally distributed data, the Mann-Whitney U test was used for two groups, and the Kruskal-Wallis test was used for three or more groups.Post-hoc analysis involved conducting Levene's test to assess the homogeneity

Inclusion criteria for volunteers
Participants had to be individuals of the University's Faculty of Health Sciences and Health Services Vocational School and willing to participate in the study.To be over 18 years old, willing to participate in the study, and not having any physical or cognitive impairments that prevent participation.

Exclusion criteria for volunteers
Participants who wished to withdraw from the study at any stage were excluded.

Expected benefits of the study
It is expected that the study will contribute to effective disaster preparedness efforts by determining the relationship between earthquake risk perception, religious orientation, and spiritual well-being in individuals with and without earthquake experience.It aims to provide a foundation for scientific research in public health and make positive contributions to the existing literature.

Start and end dates of the study and estimated duration
The data collection phase of the study was conducted between March 2023 and April 2023.
In Table 2, descriptive data regarding earthquake and spirituality for individuals with and without earthquake experience are presented.It was found that 66% of individuals with earthquake experience lived in earthquakeprone areas, and 85% of them stayed in their homes during earthquakes.Additionally, 68% of them had experienced previous disasters, 53.3% received disaster/earthquake management training, 71.3% had social security for medical examinations, 76.8% had family members employed in income-generating jobs, 79.8% did not receive any spiritual well-being-related education, and 56.1% identified themselves as religious.On the other hand, 78.9% of individuals without earthquake experience lived in earthquake-prone areas, and 80.6% stayed in their homes during earthquakes.Moreover, 93% of them had experienced previous disasters, 62.4% received disaster/earthquake management training, 69.8% had social security for medical examinations, 78.9% had family members employed in income-generating jobs, 81.8% did not receive any spiritual well-being-related education, and 55.8% identified themselves as religious (Table 2).
Table 3 presents the earthquake risk perception, religious orientation, and three-factor spiritual well-being scale and subscale averages for individuals with and without earthquake experience.Among individuals with earthquake experience, the earthquake risk perception scale averages were 33.04 ± 7.80 for the overall scale, 14.42 ± 4.64 for emotional risk, and 16.66 ± 3.71 for cognitive risk.The religious orientation scale averages were 100.65 ± 20.80 for the overall scale, 46.22 ± 8.67 for intrinsic orientation, 22.56 ± 4.90 for extrinsic orientation, and 25.97 ± 5.78 for quest orientation.The three-factor spiritual well-being scale averages were 115.13 ± 16.87 for the overall scale, 62.31 ± 12.92 for transcendence, 30.24 ± 5.25 for harmony with nature, and 21.07 ± 6.75 for anomie.Among individuals without earthquake experience, the earthquake risk perception scale averages were 31.57± 7.74 for the overall scale, 15.03 ± 4.47 for emotional risk, and 16.43 ± 3.79 for cognitive risk.The religious orientation scale averages were 96.70 ± 18.46 for the overall scale, 46.93 ± 9.02 for intrinsic orientation, 22.79 ± 5.09 for extrinsic orientation, and 26.43 ± 5.62 for quest orientation.The three-factor spiritual well-being scale averages were 114.09 ± 18.04 for the overall scale, 62.14 ± 12.62 for transcendence, 29.71 ± 5.47 for harmony with nature, and 21.95 ± 7.12 for anomie (Table 3).www.nature.com/scientificreports/According to Table 3, earthquake-experienced individuals had significantly higher earthquake risk perception, religious orientation, and three-factor spiritual well-being scores compared to those without earthquake experience (p < 0.05).
Table 4 presents the comparison of earthquake risk perception, religious orientation, and three-factor spiritual well-being scale and subscale averages between individuals with and without earthquake experience in terms of their descriptive characteristics.According to the results, the average scores of the earthquake risk perception scale were found to differ significantly based on gender (t = 4.971, p < 0.001).The average scores of the emotional risk perception subscale showed significant differences based on gender (t = 6.801, p < 0.001) and substance use (KW = 6.441, p = 0.040).Additionally, the average scores of the cognitive risk perception subscale were found to differ based on marital status (U = -2.089,p = 0.037).Furthermore, the average scores of the religious orientation scale showed significant differences based on gender (t = 3.796, p < 0.001) and substance use (KW = 16.552,p < 0.001).The average scores of the intrinsic orientation subscale showed significant differences based on gender (t = 3.705, p < 0.001) and substance use (KW = 12.656, p = 0.002).Similarly, the average scores of the extrinsic orientation subscale differed based on gender (t = 4.266, p < 0.001) and substance use (KW = 10.750,p = 0.005).The average scores of the quest orientation subscale differed based on gender (t = 2.551, p = 0.001), marital status (U = -2.097,p = 0.036), and substance use (KW = 14.991, p = 0.001), (Table 4).
In this study, there were no statistically significant differences in earthquake risk perception, religious orientation, and three-factor spiritual well-being scale and subscale averages between individuals with and without earthquake experience based on their descriptive characteristics such as the number of children, place of residence, income status, and family structure (p > 0.05).
In Table 6, hierarchical regression analysis of factors influencing individuals' earthquake risk perception is presented.In the first model, it was found that individuals' religious orientation scores significantly predicted earthquake risk perception by 7.8%.In the second model, when the three-dimensional spiritual well-being was added, the statistical significance was not compromised, and the prediction rate increased to 9.4%.In the third     www.nature.com/scientificreports/model, demographic variables were added, and it was found that being female and receiving education about spiritual well-being, in addition to religious orientation and spiritual well-being, significantly predicted earthquake risk perception by 13.5% (p < 0.001; Fig. 1).
As seen in Table 7, the logistic regression model created with earthquake experience status as the dependent variable predicts the earthquake experiences of those who received training in disaster management significantly.

Discussion
The findings of the study examining the relationship between earthquake risk perception, religious orientation, and spiritual well-being of individuals with and without earthquake experience were discussed in line with the literature.
In this study, individuals with earthquake experience were found to have statistically significantly higher scores in earthquake risk perception, religious orientation, and spiritual well-being compared to those without earthquake experience (p < 0.05).Natural disasters are experiences that pose a threat to individuals' physical safety, mental health, and social well-being, with short and long-term adverse effects in these areas.Earthquakes are natural events that endanger human health, disrupt families, and disrupt normal social interactions.It is known that the detrimental effects of earthquakes on mental health can be reduced to the extent that survivors can support themselves spiritually.Religious and spiritual beliefs can serve the purpose of providing individuals with meaning, comfort, and consistency in the face of extreme distress after negative life events 33 .Cui et al. showed in their study that individuals with earthquake experience had higher earthquake risk perception compared to those without earthquake experience 34 .In a study conducted with individuals who witnessed the earthquakes affecting many cities in February 2023, even those trapped under the debris, it was expressed that individuals lacked sufficient knowledge about earthquakes or did not take any precautions to protect themselves.They resorted to prayer and sought refuge in God during and after the earthquake.It was noted that elderly individuals who did not develop any defense mechanisms after witnessing numerous casualties in their immediate surroundings were negatively affected in terms of vulnerability 35 .In another study, university students were asked to generate metaphors regarding the 2023 earthquake.It was found that they produced metaphors such as fear, anxiety, loss, death, and faith 36 .It is believed that experiencing the earthquake, the intensity of the disaster, and the number of injured and deceased individuals in the society influence individuals' perception of earthquake risk.
This study, the average score of the earthquake risk perception scale was found to be significantly higher for women compared to men (p < 0.05).When examining the literature, it is observed, similar to our study, that gender significantly influences disaster risk perception.Women have a higher earthquake risk perception compared to men 37,38 .A study conducted after the hurricane disaster in Florida indicated that gender has an impact on disaster risk perception.Additionally, a study in Taiwan stated that women have a higher earthquake risk perception compared to men 12 .The findings of our study are in line with the existing literature.It has been Table 5. Correlation analysis of earthquake risk perception, religious orientation, three-factor spiritual wellbeing scale, and its sub-dimensions among individuals with and without earthquake experience.Figure 1.Presentation of factors ınfluencing earthquake risk perception using hierarchical regression analysis.
noted that in women, disaster risk perception is influenced by emotional and environmental factors, which in turn affect awareness and the fulfillment of requirements such as disaster preparedness 39 .The society assigning maternal and spousal roles primarily to women may lead them to have higher levels of responsibility and protective behavior compared to men, which could influence their disaster risk perceptions.Another factor affecting disaster risk perception is religious orientation.In this study, the average score of the religious orientation scale was found to be significantly higher in women than in men.Positive religious coping methods enhance psychological and physical well-being in individuals and strengthen interpersonal friendships, while negative religiousness can lead to worse physical and mental health, lower quality of life, and depression.In a study by Abdhikari 40 , it was highlighted that individuals who survived a series of natural disasters such as Hurricane Katrina, the Pakistan earthquake, the Malaysia flood, and the Chile earthquake used religious coping mechanisms to deal with psychological distress and post-traumatic stress disorder.The study emphasized the importance of gender differences in using different coping strategies among individuals affected by the earthquake.Female adults who survived tend to use more religious coping and passive coping methods, while surviving males were observed to use active coping, social coping, and self-distracting coping methods more frequently.In a study by Sohrabizade, it was stated that the positive and negative effects of religious orientation after natural disasters affect women more than men, parallel to this study 41 .The higher religious orientation in women compared to men in our study is thought to be due to the traditional acceptance of gender roles in patriarchal societies.Women are traditionally expected to adhere more to private and domestic spheres, while men take on more public roles such as leadership and management.This difference is believed to lead to variations in defense mechanisms developed against challenges between genders.
In this study, the higher religious orientation in women compared to men is thought to be due to the traditional acceptance of gender roles in patriarchal societies, where women are traditionally expected to adhere more to private and domestic spheres, while men take on more public roles such as leadership and management.This difference is believed to lead to variations in defense mechanisms developed against challenges.
In religious beliefs, prayers are considered not to be rejected by God, and adhering to the rules that religion prohibits and commands is accepted 42 .In this study, the average score on the religious orientation scale was found to be significantly higher in non-users compared to substance users.In a study conducted with university students, an inverse relationship between spirituality and alcohol use was reported, indicating lower alcohol and substance use among individuals with higher spirituality.Additionally, some studies have suggested that religious beliefs are effective as alternative treatments in substance use disorder therapy [43][44][45] .According to Turkish societal norms influenced by religious beliefs, alcohol consumption is among the prohibited behaviors.The reason for the lower religious orientation among alcohol consumers in this study aligns with the existing literature.
In this study, it was found that the average score on the three-factor spiritual well-being scale was significantly higher in women compared to men and in substance users compared to non-users.Spiritual well-being expresses an individual's commitment to oneself, the environment, and the presence of a higher power.It is known that individuals with weak spiritual well-being more frequently experience problems in their mental well-being, feelings of hopelessness, sense of meaninglessness in life, depression, etc. 46 23 .Based on all of this, it can be said that individuals' levels of spiritual well-being are important in natural disaster situations.The hierarchical regression analysis conducted in this study suggests that earthquake risk perception is associated with factors such as religious orientation, spiritual well-being, gender, and spiritual well-being education.In this context, individuals' religious orientations and beliefs can influence their earthquake risk perceptions, and spiritual well-being, defined as finding meaning and purpose in life, can contribute to a strong mental stance in individuals who have experienced disasters.Additionally, the analyses revealed gender differences in earthquake risk perception, with women in society being perceived as more emotional and empathetic.Therefore, it is hypothesized that their perception and reactions to earthquake risk are higher compared to men.Lastly, the analysis focused on the hypothesis that earthquake risk perception may vary among individuals who have received spiritual well-being education.Spirituality, which has a supportive effect on mental health, becomes an alternative in disaster situations where individuals feel more helpless, lonely, and vulnerable.Individuals whoseek support for spiritual well-being find positive responses in their psychosocial experiences.In the face of events, emotions such as anger, fear, resentment, rebellion, stress, and tension are replaced by soothing feelings such as acceptance, tolerance, generosity, and understanding [47][48][49] .Spiritual well-being education can help individuals explore their inner strengths and increase their mental resilience, enabling them to cope more effectively with stressful situations like earthquakes.
In the literature review conducted regarding the relationship between earthquake risk perception, religious orientation, and spiritual well-being of individuals with and without earthquake experience, no finding was found, which highlights the strength of the study.
Each demographic data was analyzed separately using logistic regression, and a comprehensive model was created with significant variables, revealing a statistically significant relationship between individuals who received disaster management training and their experience with disasters.Despite the absence of prior studies on this topic in the literature, our data underscores the originality of our research.

Conclusion and recommendations
In this study, the experience of earthquakes has been identified as a significant factor in individuals' disaster risk perception, religious orientations, and spiritual well-being.The study also revealed that gender, religious orientation, well-being, gender, and substance use influence individuals' disaster risk perception.Additionally, individuals' religious orientations and three-dimensional spiritual well-being explain earthquake risk perception by 13.5%.
Experiencing natural disasters such as earthquakes increases individuals' awareness of how they perceive earthquake risks, the damages caused by the disaster to society, and hence their preparedness to protect themselves.In addition, it has been observed that individuals mostly rely on their beliefs and increase their mental resilience through them to overcome the psychological trauma they experience as a result of experiencing a natural disaster such as an earthquake.While it may not be possible for every individual in society to have the experience necessary to protect themselves from earthquakes or other disasters, all individuals carry different risks in terms of various natural disasters.In our country, which is located in an earthquake zone, preventing loss of life, minimizing the environmental and psychological devastation caused by disasters, and enhancing awareness and taking necessary precautions can only be achieved through the education and increased risk perception of all members of society, especially university individuals who are the building blocks of our future.
Considering this situation, strategies can be developed to inform and educate the public correctly and prepare them for disaster situations.In our country, located in the earthquake belt with increasing natural disasters and globalization, preventing loss of life and minimizing environmental and psychological destruction caused by disasters can only be achieved through educating the entire society.Particularly, focusing on educating students, who are the building blocks of our future, and increasing awareness of disaster risk perception is crucial.It is recommended to plan educational activities targeting groups with low risk perception.Moreover, these findings may encourage similar studies to be conducted for other natural disasters.

Limitations of the study
The inclusion of only university students and healthcare departments, the absence of robust sampling methods such as stratified sampling, the use of non-parametric statistical tests, are limitations of the study.Additionally, data collection through online platforms like Google Forms, and the lack of stratified sampling, are also limitations.This study covers the immediate two-month period following the earthquake.Subsequent studies should also consider the long-term effects of the earthquake.A limitation is that an equal number of students with and without earthquake experience were not included in the study with a larger sample size.

Recommendations for future researchers
For future studies, it is advised to conduct comprehensive research with a broader and more diverse sample, including multiple universities and countries, to increase awareness and ensure the assumptions of parametric tests are met.Additionally, addressing regional and experiential factors using the stratified sampling method can lead to more reliable results.Furthermore, educational and intervention studies aimed at enhancing disaster preparedness beliefs are suggested.In these interventions, nursing initiatives, taking into account individuals' personal characteristics, religious orientation, and spiritual well-being, are recommended.In addition to the influence of religious beliefs on spiritual well-being, conducting objective research on which rituals or behaviors can positively affect students' coping mechanisms could be instructive for accelerating the return to normalcy processes for individuals affected by earthquakes. https://doi.org/10.1038/s41598-024-56641-xwww.nature.com/scientificreports/

Table 1 .
Descriptive characteristics of individuals with and without earthquake experience (N = 604).

Table 2 .
Descriptive statistics of earthquake experience and spirituality-related variables among individuals with and without earthquake experience.

Table 3 .
Mean scores of earthquake risk perception, religious orientation, and three-factor spiritual well-being scale and its sub-dimensions among individuals with and without earthquake experience.

Table 4 .
Comparison of descriptive characteristics and mean scores of earthquake risk perception, religious orientation, and three-factor spiritual well-being scale and its sub-dimensions between individuals with and without earthquake experience.*Bonferroni test, **LSD test.

Table 7 .
22Similarly,Cherry et al.show through studies conducted after Hurricane Katrina in 2005 and the Deepwater Horizon oil spill in 2010 that spiritual support effectively enhances the resilience of survivors22.Timalsina et al. suggest that spirituality can increase Prediction results of earthquake experience status using logistic regression.